Michigan Severity Rating Scales:

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1 Michigan Severity Rating Scales:The Michigan Severity Rating Scales: Tools Supported by DataWe’re very pleased to be here today to share this exciting new data with you.Sue and I have both worked on this project from the beginning and want to thank AER for this opportunity to share it with you.The information we’re sharing with you today is the result of over 15 years work by VI professionals in Michigan.We first started presenting on the scales in 2007; started being urged in 2008 to gather better data; presented at AER 2008; Cleveland 2010; AER webinar in Cleveland October 2010We approached the Department of Blindness and Low Vision Studies at Western Michigan University to guide us in gathering the data that would show that these tools are reliable in suggesting service times for Orientation & Mobility services to students in public schools. We’re grateful to Dawn and Rob for their hard work in this project.Michigan Severity Rating Scales:Solving the Puzzle of Service Delivery Time

3 Michigan Severity Rating Scales History and DevelopmentAdapted from the Montgomery County, Pennsylvania model beginning in 1995Published and disseminated by the Michigan Department of Education – Special Education Services in 1996Sue B.

4 Michigan Severity Rating Scales History and DevelopmentFirst versions – 1996 and supported by the Michigan Department of Education – Special Education Services Michigan Department of Education-Low Incidence Outreach (MDE-LIO) created and sponsored committees beginning in 2007 to revise the three existing scales and develop the O&MSRS+

5 Michigan Severity Rating Scales History and DevelopmentWeb search indicated the Scales were being used and referenced in documents in several other statesReferred to in O&M university preparation programsInternationally recognizedSue B.

6 Michigan Severity Rating ScalesWhat they are:Data collection toolsA guide based on best practicesGuideline for IEP team service discussionSusan LThe Michigan Severity Rating Scales What they are:First, As a data collection tool that helps the service provider analyze the various factors that go into deciding how much time will be required to provide the amount of service needed.Second, As a Guide Based on Best Practice*This has been somewhat informally determined even though we gathered data and reached a consensus. We recognize that a more formal determination of the validity and reliability of the tools needs to be established. We are in the beginning stages of getting assistance from those knowledgeable in research to guide us through the steps of determining this.Third, As a Guideline for IEP team service discussion:*The manner in which these tools are used for IEP Team discussion is up to the service provider*Some service providers fill out the scale at the IEP with all team members providing input*Other providers fill it out ahead of time and use the information and the data collected as the basis for the recommendation of service time and then keep it in the student’s working file

7 Michigan Severity Rating ScalesWhat they are not:Not an assessmentNot a severity of disability but a severity of student’s need for servicesNot a pre-determiner of serviceNot the only data sourceSusan LThe Michigan Severity Rating Scales: What they are not:They’re not an assessment*We need to emphasize that these are not normed assessments and should not be used as an assessment tool even though you go through an assessment process in order to determine the severity of need score in each categoryThey’re not used to determine the severity of the disability but severity of the student’s need for services*There was objection to the use of the word severity throughout the tool, but the committees decided to keep the name since it has become internationally recognized.*The phrase “severity of need” was inserted throughout the scales to keep the user focused on what the purpose of these tools is.They’re not a pre-determiner of service, but a suggestion of what may be an appropriate level of serviceAnd they’re not the only data sourceThis is only one of the sources of data that should be considered

8 Michigan Severity Rating Scales The Surveys2011 – MDE-LIO partnered with the Department of Blindness and Low Vision Studies – WMU Dr. Robert Wall-Emerson & Dr. Dawn Anderson oversaw the development of the surveys Surveys administered by MDE-LIO and sent to listserves in early 2012Susan L talk about survey process

10 Michigan Severity Rating Scales The SurveysSurvey questions included:O&M, TCVI or Dual service providerPrevious experience with the scalesWhen the Scale is completed & with whomAre the Scales used for caseload analysis and how important of a role do they play?Susan L

11 Michigan Severity Rating Scales The SurveysRespondents read scenarios and answered questions based on student profilesHow well are areas of concern covered?How well do contributing factors address adding or subtracting from service time?How well do service times match instructional needs?What are the reasons if recommended service time can’t happen?Susan L

12 Michigan Severity Rating Scales The SurveysReliability (precision)Respondents overwhelmingly identified the scales as measuring the significant factors to be considered in determining service time for O&M and Vision ServicesValidity (accuracy)O&MSRS above 90%O&MSRS %VSSRS %VSSRS %Susan L

15 Orientation & Mobility Severity Rating ScaleThe numbers attached to each severity of need are considered part of a continuum.Sue B

16 Orientation & Mobility Severity Rating ScaleEach of the Severity of Need categories is structured in terms of impact on independent travel skills as it relates to the student's age appropriate needsSue B

18 Orientation & Mobility Severity Rating ScaleSeverity of Need CategoriesRefers to the student's ability to use vision for all travel tasksSue BFor students who have mastered age or developmentally appropriate travel skills (cane travel, echolocation), score a 0 even if the visual impairment impacts the ability to use vision for travel.

20 Orientation & Mobility Severity Rating ScaleSeverity of Need CategoriesRefers to possible situations when a discrepancy exists between the student’s actual functioning in travel skills and the projected level of independence based on the O&M Specialist’s professional judgmentSue B

21 Orientation & Mobility Severity Rating ScaleSeverity of Need CategoriesRefers to the student’s ability to travel safely and proficiently in a familiar environment (i.e., school, neighborhood) based on current literature of age appropriate travel levels and expectationsSue B

23 Orientation & Mobility Severity Rating ScaleSeverity of Need CategoriesRefers to the type of environmentin which instruction is required(i.e., business district, new school, neighborhood)Sue B

24 Orientation & Mobility Severity Rating ScaleSeverity of Need CategoriesRefers to whether the student has the opportunity to use O&M skills in the community, at home, etc. outside of O&M instructional timeSue B

25 Orientation & Mobility Severity Rating ScaleTotal the right hand column to obtain a “Severity of Need Score” at the bottomSue B

28 Orientation & Mobility Severity Rating ScaleSeverity of Need SummaryLocate the range which contains the Final Severity of Need Score to determine the frequency of serviceSue B

29 Orientation & Mobility Severity Rating ScaleCompletion of the O&MSRSSam is an 8th grade student in general education classes. He has a diagnosis of ocular albinism and a recent low vision examination indicated a visual acuity of 20/200 OU. He has excellent orientation to his community and can describe routes from his house to many destinations including the names of streets in his description. He has experience using public transportation with family and friends. He rarely has access to a computer except during directed class time and has little experience using internet mapping sites for route planning or to preview unfamiliar destinations.Sue B

32 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the student's ability to use vision for all travel tasks (i.e. movement within the classroom, school building and community) as reported by the Orientation & Mobility InstructorAdd functional visionAdd cane skills

34 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the ability of the student to communicate with the O&M Specialist and benefit from instruction. Students with little ability to communicate withthe O&M Specialist may not benefit from ahigh level of direct O&M serviceSue B

35 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the impact of the additional needs on the instructional process. Students whose additional needs prevent progress in travel skills may not benefit from a high level of direct O&M serviceSue B

36 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the supervision needed to maintain the safety of the student during travelSue B

37 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the impact that the student’s level of concept development has on progress in travel skillsSue B

38 Orientation & Mobility Severity Rating Scale +Severity of Need CategoriesRefers to the amount of time needed to manage the student’s behavior so that learning can take placeSue B

39 Orientation & Mobility Severity Rating Scale +Severity of Need ScoreAs with the O&MSRS,total the right hand column to obtain a“Severity of Need Score” at the bottomSeverity of Need SummaryFill out the student informationon the second pageSue B

41 Orientation & Mobility Severity Rating Scale +Severity of Need SummaryLocate the range which contains the Final Severity of Need Score to determine the frequency of serviceSue B

42 Orientation & Mobility Severity Rating Scale +Completion of the O&MSRS+Rochelle is a severely multiply impaired student in a center based program. Her visual acuity is estimated at 20/100 in both eyes. There is no suspected field loss. She is able to use a power chair for independent mobility, however, she frequently refuses to operate the joystick and waits for staff to drive her to her destination. When motivated, she is able to negotiate around furniture and through doors, but at a very slow speed. She has little expressive language other than some inconsistent ability to point to symbols on a communication board to indicate basic wants and needs. She is dependent on others for transfers and all activities of daily living.Sue B

44 Vision Services Severity Rating ScaleSusan LThese are the scales that are used to determine the need for services from a Teacher Consultant or Teacher of the Visually Impaired.They are intended*to assist the IEP Team in the selection of a vision services delivery model for existing as well as newly identified visually impaired students.*The VSSRS and VSSRS+ will also be used to document change offrequency of services for existing visually impaired studentsThis slide shows the grid for the Vision Services Severity Rating Scale (VSSRS). This scale is intended for use with students identified as visually impaired and is primarily intended for use with students in general education settings although it may be applicable for some students with additional mild impairments.

45 Vision Services Severity Rating ScaleEach of the eight categories listed on the VSSRS, Severity of Need Profile is structured in terms of the impact on vision functioning as it relates to the student's educational programSusan LThe VSSRS Severity of Need CategoriesEach of the eight categories listed on the VSSRS, Severity of Need Profile is structured in terms of the impact on vision functioning as it relates to the student's educational program.When using the VSSRS, criteria provided within each of the categories is not all inclusive and many criteria overlap from one severity level to the next. Additional factors may influence the selection of the severity of need level by the teacher

46 Vision Services Severity Rating ScaleSeverity of Need CategoriesLevel of Vision (Medical) is identicalto the O&M ScalesSusan LThe first two severity of need categories are identical to the O&M Scales and are obtained by using the medical report from an optometrist or ophthalmologist

47 Vision Services Severity Rating ScaleSeverity of Need CategoriesRefers to the student’s level of functional near vision as determined by the TCVI or TVI (Appendix A)Susan LThe rest of the categories are specific to the services provided by the TCVI or TVICategory 3, Functional Vision, refers to the student’s level of functional near vision as determined by the TCVI or TVI and uses an appendix that is included with the VSSRS.

48 Vision Services Severity Rating ScaleSusan LHere is Appendix A which gives the Approximate Equivalent Visual Acuity according to the Distance Snellen and Jaeger charts as well as metric and point font sizes. It also gives the type of reading matter that would be equivalent for most of the sizes from bible font to newspaper headline font.

50 Vision Services Severity Rating ScaleSeverity of Need CategoriesRefers to the student's need for and use of low vision devices and technology to facilitate maximum participation in the general education curriculumSusan LCategory 5, low vision devices and technology refers to the student’s need for and use of low vision devices and technology to facilitate maximum participation in the general education curriculum.

51 Vision Services Severity Rating ScaleSeverity of Need CategoriesRefers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student's participation in their educational programSusan LCategory 6, Material preparation refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student’s participation in their educational programAdditional material preparation may be completed by a Teaching Assistant/Paraprofessional/Braillist, but is not to be considered for this rating scale.

52 Vision Services Severity Rating ScaleSeverity of Need CategoriesRefers to instruction in skills such as auditory and tactile efficiency, awareness of body in space, social skills, activities of daily living, etc.Susan LCategory 7, Compensatory Skills refers to instruction in skills such as auditory and tactile efficiency, awareness of body in space, social skills, activities of daily living, etc.

53 Vision Services Severity Rating ScaleSeverity of Need CategoriesRefers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personneland agencies concerning the student’seducational program.Susan LCategory 8, Communication with student’s team and pertinent individuals refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program.

54 Vision Services Severity Rating ScaleSeverity of Need ScoreAs with the O&M Scales,total the right hand column to obtain a“Severity of Need Score” at the bottomSeverity of Need SummaryFill out the student informationon the second pageSusan L

55 Vision Services Severity Rating ScaleSeverity of Need SummaryContributing factors are different so as to address the additional needs of students receiving Vision Services. Add or subtract .5 points. Direct Curriculum Instruction may receive more pointsIf appropriate, fill out the Contributing Factors to Service Delivery on the Student Performance Summary by adding or subtracting .5 points.Contributing Factors include:Age of studentAttendanceAvailability of materials/equipmentExpanded Core Curriculum: Prep / Instruction / Coordination Progressive conditionRecent vision lossSchool staff need for supportStudent cooperationTraining of Paraprofessional / Teaching Assistant / BraillistTransition to new school/buildingTravel timeNumerous accommodations provided by TCVI / TVIDirect Curriculum Instruction (add 1 to 4 points)Committee members felt that those students receiving direct curriculum instruction such as in math or reading should receive up to 4 additional points which are added to the final scoreThere is a line for “Other (explain)”

56 Vision Services Severity Rating ScaleSeverity of Need SummaryLocate the range which contains the Final Severity of Need Score to determine the frequency of serviceSusan L0-2 Service not indicatedtimes / yeartimes / semestertimes / month minutes eachtimes / week minutes eachor more times/week 45 or more minutes each

57 Vision Services Severity Rating ScaleCompletion of the VSSRSAshley is an 11 year girl with a history of retinopathy of prematurity according to an ophthalmology report. She has no light perception.Ashley has received TCVI services since enrolled in Early Intervention Home Based Service. She is transitioning to Middle School and is enrolled in general education classes for much of her day. She will have access to a generic special education resource room for pull out services.Ashley is a fluent Braille reader and reads often for pleasure. She struggles with math and has not mastered basic math concepts. The TCVI will provide significant follow-up to Ashley’s general education math class. Susan LAshley is an 11 year girl with a history of retinopathy of prematurity according to an ophthalmology report. She has no light perception.Ashley has received TCVI services since enrolled in Early Intervention Home Based Service. She is transitioning to Middle School and is enrolled in general education classes for much of her day. She will have access to a generic special education resource room for pull out services.Ashley is a fluent Braille reader and reads often for pleasure. She struggles with math and has not mastered basic math concepts. The TCVI will provide significant follow-up to Ashley’s general education math class.

58 Vision Services Severity Rating ScaleCompletion of the VSSRS cont.She is demonstrating an aptitude for using the braillenote and continues to improve in use of it. Use of the computer is challenging for her and she knows approximately half of the alphabet keys. She can type 8 words a minute with 60% accuracy. She is being introduced to JAWS.A certified braillist is housed at the elementary school and materials for middle school which are given ahead of time can be prepared by this person. It is anticipated that some regular material preparation / adaption will be required of the TCVI during middle school. A paraprofessional will be available for Ashley in Middle School and will be assigned to provide assistance in classes such as Science and Physical Education and others to be determined.Susan LShe is demonstrating an aptitude for using the braillenote and continues to improve in use of it. Use of the computer is challenging for her and she knows approximately half of the alphabet keys. She can type 8 words a minute with 60% accuracy. She is being introduced to JAWS.A certified braillist is housed at the elementary school and materials for middle school which are given ahead of time can be prepared by this person. It is anticipated that some regular material preparation / adaption will be required of the TCVI during middle school. A paraprofessional will be available for Ashley in Middle School and will be assigned to provide assistance in classes such as Science and Physical Education and others to be determined.

60 Vision Services Severity Rating Scale+Susan LVision Services Severity Rating Scale for Students with Additional Needs (VSSRS+) is used with students identified as visually impaired and for whom the VSSRS does not seem to meet the needs.The student does not necessarily have to have visual impairment as the primary certification.It is an informal tool primarily intended for use with students in special education settings, but could include some students in general education settings.

61 Vision Services Severity Rating Scale+Severity of Need CategoriesCategory 1 refers to the student's level of distance vision as reported by an eye care / low vision specialist and category 2 refers to the student's ability to apply visual skills to the educational settingSusan LCategory 1 refers to the student's level of distance vision as reported by an eye care / low vision specialist and category 2 refers to the student's ability to apply visual skills to the educational settingWe recognize that an adequate eye report may not be available for all students. The functional vision assessment that can be conducted by a TCVI or TVI can be used instead. Suggested methods for non-verbal students include use of Teller Acuity Cards, LEA Vision Assessment Materials, etc.

62 Vision Services Severity Rating Scale+Severity of Need CategoriesRefers to the impact of these delayson the student’s ability to benefit fromservices from the TCVI / TVISusan LThe next three categories took a great deal of time to develop. The committee wanted to be sure that students weren’t just being written off because they had additional needs. We also wanted to be sure that there was some justification for not providing intense direct services for students who were so severely multiply impaired that there was little chance of improvement of skillsCategory 3 Impact of Developmental / Communication Delays refers to the impact of these delays on the student’s ability to benefit from services from the TCVI / TVIAs in the OMSRS+, significant additional needs may impact the student’s ability to benefit from a high of level of service, so the more impact the delays have, the lower the severity of need score will be and less service time will be suggested

63 Vision Services Severity Rating Scale+Severity of Need CategoriesRefers to the ability of the student to respond to stimulation and/or instructionSusan LThis is another category where the more delays, the less likely that vision services will make an impact on the education of the student.

64 Vision Services Severity Rating Scale+Severity of Need CategoriesRefers to the level of independencein skills of daily livingSusan LCategory 5 Level of Skill in Activities of Daily Living refers to the level of independence in skills of daily living

65 Vision Services Severity Rating Scale+Severity of Need CategoriesRefers to the estimated time needed by theTCVI or TVI to modify materialsnecessary for the student's participationin their educational programSusan LCategory (6) Need for Material Preparation by the TCVI / TVI refers to the estimated time needed by the TCVI or TVI to modify materials necessary for the student's participation in their educational program and is scored exactly like the VSSRS

66 Vision Services Severity Rating Scale+Severity of Need CategoriesRefers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personneland agencies concerning thestudent’s educational programSusan LThe 7th category Need for communication with student's team / pertinent individuals by the TCVI / TVI refers to the amount of time needed for communication with school personnel, parents, medical personnel, technology support personnel and agencies concerning the student’s educational program and is scored exactly like the VSSRS, also.

67 Vision Services Severity Rating Scale+Severity of Need SummaryContributing factors are different so as to address the additional needs of these students. Add or subtract .5 points. Age of student and Direction Curriculum Instruction may receive more points.Susan LThe severity of need summary is completed as in the O&M scales and the VSSRS by determining the severity of need score and considering the contributing factors.Note that the age of the student and Direct curriculum instruction may receive up to 4 points eachCommittee members felt that a very young child with additional needs may not receive a high enough score to merit enough service time without these extra points. The same is true of direct curriculum instruction in a content area such as math or reading. It is up to the discretion of the TCVI / TVI or team filling out the scale whether additional points should be added.Other Contributing factors are the same as some of the factors in the VSSRSAttendanceAvailability of materials / equipmentConsultation and coordination of Expanded Core Curriculum ActivitiesProgressive conditionRecent vision lossSchool staff need for supportStudent cooperationTeaching of Paraprofessional / Teaching Assistant / Braillist Transition to new school / buildingOther

68 Vision Services Severity Rating Scale+Severity of Need SummaryLocate the range which contains the Final Severity of Need Score to determine the frequency of serviceSusan L

69 Vision Services Severity Rating Scale+ Completion of the VSSRS+Clark is a 3 year old with a history of trauma during delivery. He has an undiagnosed visual impairment and began a school program at the beginning of this school year in a program for students with severe multiple impairments. He does not have a blink reflex, but parents feel that he recognizes their faces and he passed a vision screening to the one month developmental level with an early intervention teacher who is not a vision services specialist. Clark did not receive services from a Teacher of the Visually Impaired prior to enrolling in school. He has extremely low tone and is unable to participate in activities of daily living. He fusses when he is not held and is difficult to quiet. Clark is in a classroom where several other children receive consultation from the TCVI.Susan L